Our Summary

Pterional craniotomy is a common surgical procedure in neurosurgery, which traditionally involves creating a hole (known as the MacCarty keyhole) in the skull. However, this can lead to a visible depression in the area around the eye, which can be cosmetically displeasing. This paper presents a new method where, instead of creating a keyhole, a small strip is removed from a different area of the skull. The results from 48 surgeries using this new method show no complications related to the approach, and patients have been pleased with the cosmetic outcomes, with no reports of visible depressions. Therefore, this new method might be a better alternative for performing this type of surgery.

FAQs

  1. What is a pterional craniotomy and how is it traditionally performed?
  2. What is the new method proposed for performing a pterional craniotomy?
  3. What have been the results and patient feedback from surgeries using this new method?

Doctor’s Tip

A doctor might tell a patient undergoing a craniotomy to follow post-operative care instructions closely, including keeping the surgical site clean and dry, taking prescribed medications, and attending follow-up appointments. They may also advise the patient to avoid strenuous activities and heavy lifting during the recovery period to prevent complications.

Suitable For

Patients who are typically recommended for craniotomy include those with brain tumors, blood clots, aneurysms, vascular malformations, traumatic brain injuries, epilepsy, and other neurological conditions that require surgical intervention. The decision to perform a craniotomy is made by a neurosurgeon after careful evaluation of the patient’s medical history, symptoms, imaging studies, and overall health status.

Timeline

Before the craniotomy:

  1. Patient undergoes a thorough evaluation and consultation with a neurosurgeon to determine the need for surgery.
  2. Pre-operative tests such as imaging scans and blood work are conducted.
  3. Patient is instructed on pre-operative preparations, which may include fasting and stopping certain medications.

During the craniotomy:

  1. Patient is placed under general anesthesia.
  2. Surgeon makes an incision in the scalp and removes a small strip of skull bone to access the brain.
  3. The necessary procedure is performed on the brain, which may involve removing a tumor, repairing a blood vessel, or relieving pressure.
  4. The bone flap is replaced and secured with plates and screws.
  5. Scalp incision is closed with sutures or staples.

After the craniotomy:

  1. Patient is closely monitored in the recovery room for any complications.
  2. Pain management and medications are provided as needed.
  3. Patient may experience some swelling, pain, and discomfort in the surgical area.
  4. Physical therapy and rehabilitation may be recommended to regain strength and function.
  5. Follow-up appointments with the neurosurgeon are scheduled to monitor recovery and assess the outcome of the surgery.

What to Ask Your Doctor

  1. What is the specific reason for recommending a craniotomy in my case?
  2. What are the potential risks and complications associated with a craniotomy procedure?
  3. How long is the recovery process expected to take after a craniotomy?
  4. Will I need any additional treatments or therapies following the craniotomy?
  5. How will the cosmetic outcome of the surgery be affected, and are there any alternatives to minimize visible depressions or scarring?
  6. What type of anesthesia will be used during the craniotomy procedure?
  7. How experienced are you in performing craniotomy surgeries?
  8. What is the success rate for this type of surgery in cases similar to mine?
  9. Will I need to undergo any additional tests or imaging before the craniotomy?
  10. What are the expected long-term effects or outcomes of the craniotomy surgery?

Reference

Authors: Moscovici S, Mizrahi CJ, Margolin E, Spektor S. Journal: J Clin Neurosci. 2016 Feb;24:135-7. doi: 10.1016/j.jocn.2015.07.010. Epub 2015 Oct 9. PMID: 26455544